Converting public health insurance into guideline-concordant mental health care ABSTRACT The Medicaid program spends $26.4 billion on mental health care, yet underuse and misuse of recommended treatment and associated adverse and costly clinical events are prevalent. Major gaps persist in our knowledge of how to convert public health insurance into guideline-concordant mental health care, care that is consistent with evidence-based practice. The proposed Career Development Award would allow Dr. Burns to supplement her expertise in health care policy and economics with the clinical, quality assessment, and additional economic training necessary to lead clinically and policy-relevant research on the economics of public health insurance design for adults with serious mental illness (SMI). The specific training aims are: 1) to develop knowledge of the natural history and treatment of SMI and the clinical challenges to providing guideline- consistent treatment to very low-income adults with SMI; 2) to expand knowledge about the economic incentives created for patients and clinicians by specific features of public health insurance design; 3) to acquire expertise in developing treatment quality measures that are informed by clinical expert guidelines and can be applied to administrative data. Dr. Burns will be guided by her mentor, Stephen Soumerai, ScD, and co-mentors Jack Burke, MD, MPH, and Haiden Huskamp, PhD. Her career development plan includes coursework and guided study with: Dr. Burke on clinical issues and evidence-based care for SMI treatment; Dr. Soumerai, on mental health care policy and the development of quality measures; and Dr. Huskamp, on the economics of health insurance and mental health care policy. Dr. Burns will use the knowledge and skills acquired through these career development activities to conduct three studies. The first examines the extent to which the simplification of state Medicaid enrollment and renewal requirements influences Medicaid or private health insurance coverage for adults with SMI and other disabilities. The second evaluates the effects of eliminating annual visit limits for psychotherapy and medical care on mental health care use, including guideline-concordant care, and cost for publicly insured adults with SMI. The third assesses the extent to which changes in the generosity of Medicaid psychiatrist fees are associated with changes in psychiatrist participation in Medicaid, and beneficiary access to, and use of, mental health care. The proposed K01 Award will provide Dr. Burns with the training, mentoring, and resources needed to lead independent research in mental health care policy, focusing on the links between the economics of public health insurance, health care delivery, and mental health treatment quality for low-income adults with SMI.